India’s coronavirus data can best even its sceptic critics

We must be sceptical even of our scepticism” (Bertrand Russell)

It’s good to be sceptic in general. Scepticism in the domain of science helps one question the existing body of knowledge and make new discoveries. At an individual level, it helps us question our assumptions and refine our thoughts. As humans, we often tend to be sceptic when something doesn’t turn out to be what we had expected it to be. Around mid-March 2020, when most Indians were getting aware of the terms Coronavirus and COVID- 19, and when cases of Indians infected by Coronavirus started to figure in the news headlines, there were various projections made about the likely number of infections and death in India due to coronavirus over different time periods.

According to some projections, India was expected to witness 30 Crore infections (best case prediction being of 20 Crore) with 1 Crore infections within a window of 2 to 3 weeks. Another estimate put the number of infections between 30 to 50 crore in a period of 4 months. Then, there were those who predicted India to have 13 lakh coronavirus-infected patients by mid-May. Projections for death ranged between 10 lakh to 50 lakhs. Taking an opposite viewpoint, a few believed that India won’t see any spike in coronavirus cases and will have negligible impact because of Coronavirus.

Truth is stranger than fiction and life is stranger than predictions. Looking at the figures for coronavirus in India till 29th April 2020, one can observe that the actual trajectory of infections and deaths doesn’t seem to mirror either ends of predictions. Neither has been the impact negligible in India nor have we witnessed catastrophe dire warnings had us prepare for. These have, therefore, led to many doubting the official infection and fatality count released by the Indian government. The reasons for being sceptic range from relatively low testing carried out in India so far, the perennial doubt on the capacity of governments to manage large scale disasters, the significant variations from projections and especially the global trajectory (especially European countries and the USA), and the politics of federal structure in India.

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While I mention this, I would like to add the disclaimer that I am writing this with an abundance of caution. The intent is not to trivialise the predictions or those who made those predictions but to closely look at the figures and draw some inferences that could help us better understand what the numbers seem to suggest. Numbers often conceal more than what they reveal. So let us try to look into the two sets of numbers- infection count and fatality count- and the more common doubts many have raised.

Let us begin with infection count. As on 1st May 2020, the world had 33,41,311 positive cases while the count in India stood at 37,257. For a country having almost 18% of global population, a share of 1.11% in confirmed cases seems to be far too low. What could be the reasons?

Perhaps, India is not testing enough. Testing falls under the purview of state governments in India and based  on the different contexts, infection spread (perceived and/or actual), fiscal and administrative capacities, and policies for testing, different states have different testing rates. The testing rate, whether measured on a per day basis or per million population basis, has gone up in all Indian states in the last one month but is still very low compared to most countries in the world. You can’t figure out infections if you don’t test. It becomes more important in case of coronavirus because of large number of asymptomatic cases. So it can be reasonable to expect that as India carries out more tests, more people will come out as positive (infected) and the number count will increase.

Perhaps the tests are faulty. There have been many reports of testing kits being faulty and throwing up many false positives (people not infected are testing positives) and more importantly false negatives (infected people testing negative). If a large number of kits are faulty, especially in case of many false negatives, doubts will be raised over the actual number of infections.

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Perhaps there is some deliberate underrepresentation by governments. It is possible that in some states, state level politics and policy influence who is being categorised as positive. It is also possible that the central government (which pools in data from the state governments) is under reporting the actual count for some political, economic, or strategic concerns. However for the latter to persist for a long time and for states and political parties not to contest central government figures, seem unlikely. Especially when a higher figure could give political fodder to the opposition parties, at both central and state level.

Perhaps contact tracing hasn’t been carried out well. Many governments in India were slow to start testing and tracing first-level and second-level contacts of those who tested positive. It is also likely that many who had symptoms didn’t present themselves for testing for fear of being quarantined away from family, often at facilities with not the best of facilities and provisions, and the inconvenience that comes with it.

Based on above arguments, it seems fairly reasonable to deduce that reported infection counts are more likely to be less than the actual infection count. What about the death rates then? Let us look at the figures for death rates and the typical doubts.

As on 1st May 2020, the global coronavirus related fatalities stood at 2,38,380 while the figures for India were 1,223 or about 0.51% of global fatalities. This share is even less than the infection count share mentioned above (1.11%), and both these values are much less than the share of Indian population (18%). What could be the reasons for such low values?

Perhaps, there is a large underrepresentation by the government and many more are dying because of coronavirus. Maybe there have been many coronavirus related deaths that have either not yet been accounted for (e.g. deaths happening in rural areas, deaths not reported in government figures so far) or have been clubbed under other categories (e.g. old age or some illness) for some reasons.

However, there are some reasons why such underrepresentation is unlikely to be large. The first is that unlike infections, one doesn’t need any test to know whether one is dead or not. An infected patient can remain hidden for a few days, physically or statistically, but a dead person is unlikely to escape the eyes of any district administration for long. The dead bodies will have to be brought to either the hospital or cremation sites, each of which is finite in number and more closely guarded during these times. Data collection and reporting is also much easier when one has to collect data from a limited number of sources.

Recent reports suggest the mortality rates in India have fallen from the usual pre-coronavirus period numbers and there hasn’t been any surge in the number of dead bodies arriving at hospitals, crematoriums, and funeral sites. An infected person can remain ‘hidden’ for fear of being quarantined but if and when condition gets serious, the fear of being
dead would overpower the fear of being quarantined, even for asymptomatic patients. Media reports from Indian hospitals don’t indicate any large scale instances of hundreds of patients turning up critically ill because of coronavirus.

The second reason why underreporting is unlikely, at least on a large scale, is because of the federal and democratic nature of India. At a time when there are a number of different states, and a number of different political parties in power in those states, any such manoeuvre by any state government would not go unnoticed by the other states or by the opposition parties in states, who would in turn try to make it a political issue. In the case of infections we are seeing that happening right now but in the case of deaths, barring a couple of states, there haven’t been any such reports of any major or minor political party accusing any state or central government of hiding figures in large numbers.

The third reason, and closely related to the above reason, is the presence of large number of local, regional, and national media organisations in our country. The importance of a free and independent media in upholding our democratic values in India often goes unnoticed. If any or all governments were trying to project a false image of death rate in the country, it would not have got unnoticed from media outlets for so long. Had coronavirus been a wildfire in India and people would be getting infected and dying in much large numbers, we would have seen or read about such reports in local, regional, or national media. Data for sale of flu drugs in India for the period of January to March 2020 reveal that the overall sales of anti-infective, analgesics, respiratory drugs and other drugs have remained the same for the three months, hinting at no undetected wildfire.

So, what can we make out from the above arguments for death rates? It seems fairly reasonable to deduce that the official death count isn’t likely to be much different from the actual death count.

In addition to the above arguments, we can look around and look at what is happening in Pakistan, Bangladesh, Nepal and Sri Lanka. As on 1st May 2020 when India had 37,257 reported infections and 1,223 reported deaths, Pakistan had 18,092 and 417 respectively, Bangladesh had 8.238 and 170 respectively, Nepal had 59 and 0, and Sri Lanka had 690 and 7 respectively. The death rates for India stood at 3.28%, Pakistan at 2.30%, Bangladesh at 2.06%, Nepal at 0%, Sri Lanka at 1.01% (global figure currently stands at 7.13%). The three countries- India, Pakistan, and Bangladesh all feature among the top 10 populous countries in the world. Together, they account for 22.89% of world population (1.747 billion out of 7.631 billion) but account for just 1.90% of global infections and 0.75% of global deaths.

So the figures and fatality rates we are witnessing in India are not too different from our neighbouring countries with whom we share many similarities in race, customs, food, weather and others. All these countries also have many similar issues when it comes to broad societal and developmental indicators and maybe all these countries reported figures are much less than the actual figures. Or perhaps, there’s a simpler explanation that for some reasons, not fully known to us right now, coronavirus spread and fatality isn’t as severe in South Asia as much as in some of the other parts of the world.

One important, but often ignored, aspect is important to be mentioned at this point. For many, these numbers, whether of infection count or fatalities or percentages are just numbers while for a few, each of these numbers mean the world. Each of those numbers refer to a human being. Numbers often generate emotions, especially during times like these, and those emotions can further add to the misery or fear of people. Each of the deaths, in India or in other countries, due to the Coronavirus is extremely sad and unfortunate and the pain is felt not just by the immediate family members of the deceased but many others who may not have known the person. While the infection and death count in India is very sad and alarming, it is important to consider for a moment that the count as yet is not as high as majority of predictions had predicted.

Now we don’t know today, and we won’t know for some time, all the possible and actual reasons for figures in India to be low so far. Perhaps it is due to weather (sunlight and heat), or humidity, or lesser median age of population, or universal BCG vaccination policy, or our dietary habits, or the time and extent of complete lockdown in India, or exemplary administration of the lockdown by police and civic authorities, or a combination of one or more reasons, or some other yet unknown or established reasons. But should our lack of a better understanding of those reasons and the deviation of Indian figures (so far) from the projections of various models be a cause for being sceptical about the figures that we are seeing in front of us? A case of being sceptical about the scepticism?

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-Author Kalyan Bhaskar is a faculty in the Strategic Management Area at XLRI, Jamshedpur. At XLRI, he teaches courses on Public Policy and Business Sustainability and has also taught at IIM Lucknow and IIM Indore. He is a Fellow (PhD in Public Policy) of IIM Ahmedabad.